Changing Risk of In-Hospital Cardiac Arrest in Children Following Cardiac Surgery in Victoria, Australia, 2007–2016

Heart Lung Circ. 2019 Dec;28(12):1904-1912

The IHCA rate following cardiac surgery has more than halved over the last decade; children who experience IHCA also have lower mortality than in previous years.

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Background

Reported incidence of in hospital cardiac arrest (IHCA) after paediatric cardiac surgery varies between 3–4% in high income countries and this risk may have changed over time. We sought to examine this trend in detail.

Methods

A retrospective observational study of 3,781 children who underwent 4,938 cardiac surgeries between 1 January 2007 and 31 December 2016 in a tertiary children’s hospital. IHCA was defined as cessation of cardiac mechanical activity requiring cardiac massage for ≥1 minute. Surgical complexity was categorised using risk adjusted congenital heart surgery (RACHS-1) category. Poisson regression was used to analyse trends for every two-year period.

Results

There were a total of 211 (4.3%) IHCA events after surgery. These patients were younger, more likely to have had a premature birth, have a chromosomal or genetic syndrome association and have a high surgical complexity. Overall, there was a 52% reduction in IHCA rate over 10 years: reducing from 5.4 /100 surgeries in 2007–08 to 2.6/100 surgeries in 2015–16 (p-trend = <0.001). The reduction was mainly seen in low-to-moderate risk categories (RACHS-1 categories 1–4) and not in high risk categories (RACHS-1 category 5–6). Children in high risk categories were 13.6 times more likely to experience an IHCA (compared to low risk categories). Overall hospital mortality for children suffering IHCA decreased from 42.5/100 patients in 2007–08 to 11.1/100 patients in 2015–16 (p-trend = 0.037).

Conclusions

The IHCA rate following cardiac surgery has more than halved over the last decade; children who experience IHCA also have lower mortality than in previous years. High risk procedures still have a substantial rate of IHCA and efforts are needed to minimise the burden further in this population.